DGI:Opportunistische Infektionen/Kryptokokkose/Therapie/Kalkulierte Therapie: Difference between revisions

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=== Kalkulierte Therapie ===


{| class="wikitable sortable bs-exportable MsoTableGrid" border="1" cellspacing="0" cellpadding="0" align="left" width="775" style="border-collapse:collapse;mso-table-layout-alt:fixed;"
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| style="width:99.0pt;" width="132" |<span style="font-size:8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
!Klinische Situation
  minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
!Präferenz
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
!Substanz
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">'''Klinische Situation'''</span>
!Dosierung
| style="width:92.15pt;" width="123" |<span style="font-size:
!Dauer
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
!Kommentar
  mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
|-  
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
| rowspan="4" |Induktionstherapie
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">'''Präferenz'''</span>
| rowspan="2" |Therapie  der 1. Wahl
| style="width:106.5pt;" width="142" |<span style="font-size:
|Liposomales Amphotericin B
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
|1  x 3-4 mg/kg i.v./pro Tag
  mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
| rowspan="2" |≥ 2 Wochen
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
|
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">'''Substanz'''</span>
*'''Cave:''' Liposmales  Amphotericin B engmaschige Kontrollen von Kalium, Magnesium, Kreatinin und  Hämoglobin.
| style="width:99.25pt;" width="132" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">'''Dosierung'''</span>
| style="width:42.5pt;" width="57" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">'''Dauer'''</span>
| style="width:5.0cm;" width="189" |<span style="font-size:
  8.0pt;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">'''Kommentar'''</span>
|- style="height:167.15ptpx;"
| rowspan="4" style="width:99.0pt;" width="132" |<span style="font-size:8.0pt;line-height:
  150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Induktionstherapie </span>
| rowspan="2" style="width:92.15pt;" width="123" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Therapie  der 1. Wahl</span>
| style="width:106.5pt;" width="142" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Liposomales</span> [https://abbuch.uk-koeln.de/index.php/Antimykotika#Amphotericin_B.2C_liposomales <span style="color: windowtext">Amphotericin B</span>]
| style="width:99.25pt;" width="132" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">1  x 3-4 mg/kg i.v./pro Tag</span>
| rowspan="2" style="width:42.5pt;" width="57" |'''<span style="font-size:8.0pt;line-height:150%;mso-no-proof:yes">≥ </span>'''2 Wochen
| style="width:5.0cm;" width="189" |<span style="font-size:
  8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
  minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Cave: Liposmales  Amphotericin B engmaschige Kontrollen von Kalium, Magnesium, Kreatinin und  Hämoglobin.</span>


<span style="font-size:
*Falls Flucytosin  nicht mit liposomalem Amphotericin B kombiniert werden kann, ist auch eine Monotherapie  mit liposomalem Amphotericin B über 4-6 Wochen oder eine  Kombinationstherapie mit Fluconazol möglich<ref name=":0">Spec A, Mejia-Chew C, Powderly WG, Cornely OA. EQUAL Cryptococcus Score 2018: A European Confederation of Medical Mycology Score Derived From Current Guidelines to Measure QUALity of Clinical Cryptococcosis Management. Open Forum Infect Dis. 2018;5(11):ofy299.</ref>.
  8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
|-  
  minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
|Flucytosin
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
|100  mg/kg aufgteilt in 4 Einzeldosen pro Tag
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Falls Flucytosin  nicht mit <span style="mso-spacerun:yes"> </span>liposomalem</span> [https://abbuch.uk-koeln.de/index.php/Antimykotika#Amphotericin_B.2C_liposomales <span style="color: windowtext">Amphotericin B</span>] <span style="font-size:8.0pt;line-height:150%;
|
  font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:
*'''Cave:''' engmaschige Blutbildkontrollen  (Panzytopenie).
  Calibri;mso-fareast-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;
  mso-bidi-font-family:Arial;mso-bidi-theme-font:minor-bidi;mso-fareast-language:
  EN-US;mso-no-proof:yes">kombiniert werden kann, ist auch eine Monotherapie  mit <span style="mso-spacerun:yes"> </span>liposomalem</span> [https://abbuch.uk-koeln.de/index.php/Antimykotika#Amphotericin_B.2C_liposomales <span style="color: windowtext">Amphotericin B</span>] <span style="font-size:8.0pt;line-height:150%;
  font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:
  Calibri;mso-fareast-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;
  mso-bidi-font-family:Arial;mso-bidi-theme-font:minor-bidi;mso-fareast-language:
  EN-US;mso-no-proof:yes">über 4-6 Wochen oder eine  Kombinationstherapie mit Fluconazol möglich</span><sup><span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">24.</span></sup><span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">.</span>
|- style="height:64.75ptpx;"
| style="width:106.5pt;" width="142" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Flucytosin</span>
| style="width:99.25pt;" width="132" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">100  mg/kg aufgteilt in 4 Einzeldosen pro Tag</span>
| style="width:5.0cm;" width="189" |<span style="font-size:
  8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
  minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Cave: engmaschige Blutbildkontrollen  (Panzytopenie).</span>


<span style="font-size:
*Keine Anwendung von  Brivudin bei Flucytosin.
  8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
|-  
  minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
| rowspan="2" |Therapie  der 2. Wahl
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
(WHO-Schema<ref name=":1">In: Guidelines for The Diagnosis, Prevention and Management of Cryptococcal Disease in HIV-Infected Adults, Adolescents and Children: Supplement to the 2016 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Geneva2018.</ref>)
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Keine Anwendung von  Brivudin bei Flucytosin.</span>
|Fluconazol
|- style="height:72.0ptpx;"
|1200  mg/Tag*
| rowspan="2" style="width:92.15pt;" width="123" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
| rowspan="2" |≥ 2  Wochen
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
|*Gemäß der IDSA/CDC  Leitlinie kann  auch eine geringer Fluconazoldosis (400-800mg/Tag) in Kombination mit Flucytosin gewählt werden.
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Therapie der 2. Wahl</span>


<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
*Falls Flucytosin  nicht mit Fluconazol kombiniert werden kann, ist  Monotherapie mit Fluconazol 1200mg/Tag  möglich<ref name=":2">Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. . Available at <nowiki>http://aidsinfonihgov/contentfiles/lvguidelines/adult_oipdf</nowiki>  Accessed on 02 02 2020W1-W18</ref>.
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
|-  
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
|Flucytosin
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">(WHO-Schema<sup>20</sup>)</span>
|100 mg/kg aufgteilt in 4 Einzeldosen pro Tag
| style="width:106.5pt;" width="142" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
|
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
*'''Cave:''' engmaschige Blutbildkontrollen (Panzytopenie).  
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Fluconazol</span>
| style="width:99.25pt;" width="132" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">1200 mg/Tag*</span>
| rowspan="2" style="width:42.5pt;" width="57" |'''<span style="font-size:8.0pt;line-height:150%;mso-no-proof:yes">≥ </span>'''2 <span style="mso-spacerun:yes"> </span>Wochen
| style="width:5.0cm;" width="189" |<span style="font-size:
  8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
  minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">*Gemäß der IDSA/CDC  Leitlinie</span><sup><span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">3</span></sup> <span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">kann auch eine geringer Fluconazoldosis (400-800mg/Tag) in Kombination mit  Flucytosin gewählt werden.</span>


<span style="font-size:
*Keine Anwendung von  Brivudin bei Flucytosin.
  8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
|-  
  minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
|Konsolidierungstherapie
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
|Therapie  der 1. Wahl<ref name=":1" />
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Falls Flucytosin  nicht mit Fluconazol kombiniert werden kann, ist<span style="mso-spacerun:yes"> </span> Monotherapie mit Fluconazol 1200mg/Tag  möglich</span><sup><span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
|Fluconazol
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
|800  mg/Tag
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
|≥ 8  Wochen
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">3</span></sup><span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
|
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
|-  
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
|Konsolidierungstherapie
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">.</span>
|Therapie  der 2. Wahl<ref name=":3">Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2010;50(3):291-322.</ref>
|- style="height:72.0ptpx;"
|Itraconazol
| style="width:106.5pt;" width="142" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
|200mg  2 x tgl.
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
|≥ 8  Wochen
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
|
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Flucytosin</span>
*Bei Itraconazol  sollte ein therapeutisches Drugmonitoring (TDM) durchgeführt werden<ref name=":0" />.
| style="width:99.25pt;" width="132" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
|-  
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
|Erhaltungstherapie  (Sekundärprophylaxe)
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
|Therapie  der 1. Wahl
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">100  mg/kg aufgteilt in 4 Einzeldosen pro Tag</span>
|Fluconazol
| style="width:5.0cm;" width="189" |<span style="font-size:
|200  mg/Tag
  8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
|≥ 12  Monte
  minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
|
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
|-  
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Cave: engmaschige Blutbildkontrollen  (Panzytopenie). <span style="mso-spacerun:yes"> </span></span>
|Erhaltungstherapie  (Sekundärprophylaxe)
 
|Therapie  der 2. Wahl<ref name=":2" /><ref name=":3" />
<span style="font-size:
|Itraconazol
  8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
|200mg  2 x tgl.
  minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
|≥ 12  Monte
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
|
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Keine Anwendung von  Brivudin bei Flucytosin.</span>
*Bei Itraconazol  sollte ein therapeutisches Drugmonitoring (TDM) durchgeführt werden<ref name=":0" />.
|- style="height:48.6ptpx;"
| style="width:99.0pt;" width="132" |<span style="font-size:8.0pt;line-height:
  150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Konsolidierungstherapie </span>
| style="width:92.15pt;" width="123" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Therapie  der 1. Wahl<sup>20</sup></span>
| style="width:106.5pt;" width="142" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Fluconazol</span>
| style="width:99.25pt;" width="132" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">800  mg/Tag</span>
| style="width:42.5pt;" width="57" |'''<span style="font-size:8.0pt;line-height:150%;mso-no-proof:yes">≥ </span>'''<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">8  Wochen</span>
| style="width:5.0cm;" width="189" |
|- style="height:55.7ptpx;"
| style="width:99.0pt;" width="132" |<span style="font-size:8.0pt;line-height:
  150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Konsolidierungstherapie </span>
| style="width:92.15pt;" width="123" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Therapie  der 2. Wahl<sup>17</sup></span>
| style="width:106.5pt;" width="142" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Itraconazol</span>
| style="width:99.25pt;" width="132" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">200mg  2 x tgl</span>
| style="width:42.5pt;" width="57" |'''<span style="font-size:8.0pt;line-height:150%;mso-no-proof:yes">≥ </span>'''<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">8  Wochen</span>
| style="width:5.0cm;" width="189" |<span style="font-size:
  8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
  minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Bei Itraconazol  sollte ein therapeutisches Drugmonitoring (TDM) durchgeführt werden</span><sup><span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">24</span></sup><span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">.</span>
|- style="height:72.0ptpx;"
| style="width:99.0pt;" width="132" |<span style="font-size:8.0pt;line-height:
  150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Erhaltungstherapie  (Sekundärprophylaxe)</span>
| style="width:92.15pt;" width="123" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Therapie  der 1. Wahl</span>
| style="width:106.5pt;" width="142" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Fluconazol</span>
| style="width:99.25pt;" width="132" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">200  mg/Tag</span>
| style="width:42.5pt;" width="57" |'''<span style="font-size:8.0pt;line-height:150%;mso-no-proof:yes">≥ </span>'''<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">12  Monte</span>
| style="width:5.0cm;" width="189" |
|- style="height:72.0ptpx;"
| style="width:99.0pt;" width="132" |<span style="font-size:8.0pt;line-height:
  150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;
  mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Erhaltungstherapie  (Sekundärprophylaxe)</span>
| style="width:92.15pt;" width="123" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Therapie  der 2. Wahl<sup>3,17</sup></span>
| style="width:106.5pt;" width="142" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Itraconazol</span>
| style="width:99.25pt;" width="132" |<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">200mg  2 x tgl</span>
| style="width:42.5pt;" width="57" |'''<span style="font-size:8.0pt;line-height:150%;mso-no-proof:yes">≥ </span>'''<span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">12  Monte</span>
| style="width:5.0cm;" width="189" |<span style="font-size:
  8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:
  minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:minor-latin;
  mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;mso-bidi-theme-font:
  minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">Bei Itraconazol  sollte ein therapeutisches Drugmonitoring (TDM) durchgeführt werden</span><sup><span style="font-size:8.0pt;line-height:150%;font-family:&quot;Calibri&quot;,sans-serif;
  mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
  minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:Arial;
  mso-bidi-theme-font:minor-bidi;mso-fareast-language:EN-US;mso-no-proof:yes">24.</span></sup>
|}
|}
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Latest revision as of 11:14, 13 March 2023

Klinische Situation Präferenz Substanz Dosierung Dauer Kommentar
Induktionstherapie Therapie der 1. Wahl Liposomales Amphotericin B 1 x 3-4 mg/kg i.v./pro Tag ≥ 2 Wochen
  • Cave: Liposmales Amphotericin B engmaschige Kontrollen von Kalium, Magnesium, Kreatinin und Hämoglobin.
  • Falls Flucytosin nicht mit liposomalem Amphotericin B kombiniert werden kann, ist auch eine Monotherapie mit liposomalem Amphotericin B über 4-6 Wochen oder eine Kombinationstherapie mit Fluconazol möglich[1].
Flucytosin 100 mg/kg aufgteilt in 4 Einzeldosen pro Tag
  • Cave: engmaschige Blutbildkontrollen (Panzytopenie).
  • Keine Anwendung von Brivudin bei Flucytosin.
Therapie der 2. Wahl

(WHO-Schema[2])

Fluconazol 1200 mg/Tag* ≥ 2  Wochen *Gemäß der IDSA/CDC Leitlinie kann auch eine geringer Fluconazoldosis (400-800mg/Tag) in Kombination mit Flucytosin gewählt werden.
  • Falls Flucytosin nicht mit Fluconazol kombiniert werden kann, ist  Monotherapie mit Fluconazol 1200mg/Tag möglich[3].
Flucytosin 100 mg/kg aufgteilt in 4 Einzeldosen pro Tag
  • Cave: engmaschige Blutbildkontrollen (Panzytopenie).  
  • Keine Anwendung von Brivudin bei Flucytosin.
Konsolidierungstherapie Therapie der 1. Wahl[2] Fluconazol 800 mg/Tag ≥ 8 Wochen
Konsolidierungstherapie Therapie der 2. Wahl[4] Itraconazol 200mg 2 x tgl. ≥ 8 Wochen
  • Bei Itraconazol sollte ein therapeutisches Drugmonitoring (TDM) durchgeführt werden[1].
Erhaltungstherapie (Sekundärprophylaxe) Therapie der 1. Wahl Fluconazol 200 mg/Tag ≥ 12 Monte
Erhaltungstherapie (Sekundärprophylaxe) Therapie der 2. Wahl[3][4] Itraconazol 200mg 2 x tgl. ≥ 12 Monte
  • Bei Itraconazol sollte ein therapeutisches Drugmonitoring (TDM) durchgeführt werden[1].


  1. ↑ 1.0 1.1 1.2 Spec A, Mejia-Chew C, Powderly WG, Cornely OA. EQUAL Cryptococcus Score 2018: A European Confederation of Medical Mycology Score Derived From Current Guidelines to Measure QUALity of Clinical Cryptococcosis Management. Open Forum Infect Dis. 2018;5(11):ofy299.
  2. ↑ 2.0 2.1 In: Guidelines for The Diagnosis, Prevention and Management of Cryptococcal Disease in HIV-Infected Adults, Adolescents and Children: Supplement to the 2016 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Geneva2018.
  3. ↑ 3.0 3.1 Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. . Available at http://aidsinfonihgov/contentfiles/lvguidelines/adult_oipdf  Accessed on 02 02 2020W1-W18
  4. ↑ 4.0 4.1 Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2010;50(3):291-322.
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